L2 Scalp and Face

7/30/2019 L2 Scalp and Face

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SCALPLayers of the scalp (SCALP ) Skin C onnective tissue layer , dense & fibrous. It is adherent to the overlying skin and the underlying

muscle layer . It contains vessels and nerves of the scalp.

Skin

Superficial fascia

Aponeurosis

Loose areolartissue

Pericranium

Bone

Bl. vessels& nerves

O ccipitofrontalis , a musculo-fibrous sheet extending from the highest nuchal lines to the eye brows.Consists of 2 occipital and 2 frontal bellies connected by the epicranial aponeurosis .

L oose areolar tissue P ericranium , the outer periosteum


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Epicranialaponeurosis

Frontal belly

Occipital belly

Temporal line

Occipito-frontalis muscle Formed of 2 frontal bellies and 2 occipital bellies connected together by the epicaranial aponeurosis The frontal bellies are attached to the skin of forehead and eye brows, no bony attachment The occipital bellies are attached to the highest nuchal lines The frontal belly is supplied by the temporal branches of facial nerve The occipital belly is supplied by the posterior auricular branch of facial nerve


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Arterial Supply of the Scalp

Supratrochlear artery (from ophthalmic a, ICA )

Supraorbital artery (from ophthalmic a, ICA )

Superficial temporal artery (from ECA )

Posterior auricular artery (from ECA )

Occipital artery (from ECA )

Supratrochlearartery

Supraorbital a

Superficialtemporal a

Posteriorauricular a

Occipital a

External carotid a

Internal carotid a

Common carotid a

Maxillary a

Wounds of the scalp Because the superficial fascia of the scalp is dense , fibrous and adherent to the vessel walls, the arteries

of the scalp do not retract or contract when they are cut, leading to profuse bleeding from scalp wounds.

The scalp is supplied by 5 arteries on each side Three arteries lie in front of the auricle and 2 behind the auricle


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Nerve Supply of the Scalp Sensations from the scalp in front of the auricle are carried by branches of trigeminal nerve Sensations from the scalp behind the auricle are carried by branches of cervical nerves .

Supraorbital n

Supratrochlear n

Zygomatico-temporal n

Auriculo-temporal n

Temporal branchesof facial n

Posteriorauricular n

Greatauricular n

Lesser

occipital n

3rd occipital n

Greateroccipital n

Nerves in front of the auricle :1. Supratrochlear nerve (from ophthalmic n).2. Supraorbital nerve (from ophthalmic n).3. Zygomatico-temporal nerve (from maxillary n).4. Auriculotemporal nerve (from mandibular n).5. Temporal branches of facial nerve ( motor ), supply the frontal bellies of occipto-frontalis muscle

- The scalp is supplied by 10 nerves on each side- Five of the 10 nerves lie in front of the auricle and 5 lie behind the auricle- Four of the 5 nerves are sensory and one is motor


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Nerves behind the auricle:1. Great auricular nerve (from cervical plexus C2,3)2. Lesser occipital nerve (from cervical plexus C2)3. Greater occipital nerve (from dorsal ramus of C 2)4. 3 rd occipital nerve (from dorsal ramus of C

3)

5. Posterior auricular branch of facial nerve ( motor ), supplies the occipital belly of occipito-frontalis m.

Supraorbital n

Supratrochlear n

Zygomatico-temporal n

Auriculo-temporal n

Temporal branchesof facial n

Posteriorauricular n

Greatauricular n

Lesseroccipital n

3rd occipital n

Greateroccipital n


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Muscles of the Face

Muscles of the Eyelids Orbicularis oculi Levator palpebrae suprioris Corrugator supercilli

Muscles of the Nose Procerus Nasalis Depressor septi

Muscles of the Mouth Levator labii superioris alaeque nasi Levator labii superioris Levator anguli oris Zygomaticus minor Zygomaticus major Risorius Depressor anguli oris Depressor labii inferioris Mentalis Platysma

Buccinator Obribularis oris

Muscles of the Auricle Auricularis anterior Auricularis superior Auricularis posterior

They are called muscles of facial expression They are mainly inserted into the skin of the face They are all ( except the levator palpebrae superioris )

supplied by branches from the facial nerve

Classification of Muscles of the Face

Scalp muscles Occipito-frontalis


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Auricularis anterior,superior & posterior

Occipital belly of occipito-frontalis

Buccinator

Risorius

Depressor anguli oris

platysma

Nasalis

Frontal bellies of occipito-frontalis Procerus

Corrugator supercilli

Orbital part of orbicularis oculi

Palpebral part of oribicularis oculi

Levator labiisuperioris alaeque nasi

Levator labiisuperioris

Zygomaticus minor

Zygomaticus major

Orbicularis oris

Risorius


Depressor labii inferiorisMentalis

Depressor septi nasi

Levatoranguli oris

Nasalis

Platysma


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Dilator muscles of the lips All the dilators of the lips take origin from

bones and facia around the oral orifice They are inserted into the lips Action : They separate , elevate or depress

the lips or their angles.

Orbicularis oris Origin : maxilla and mandible Insertion : forms loops around the oral orifice Action : compresses lips together

Frontal bellies of occipito-frontalis Procerus

Corrugator supercilli


Palpebral part of oribicularis oculi

Levator labii

superioris alaeque nasi

Levator labiisuperioris

Zygomaticus minor

Zygomaticus major

Orbicularis oris

Risorius


Depressor labii inferiorisMentalis

Depressor septi nasi

Levatoranguli oris

Nasalis

Platysma

PlatysmaIt takes origin from the deep facia coveringpectoralis major and the clavicle and insertsinto the base of the mandible and angle of the mouth.


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BuccinatorOrigin : Maxilla, above the 3 molar teeth

Pterygomandibular raphe Mandible below the 3 molar teeth.

Insertion : Upper fibers insert into upper lip Lower fibers insert into lower lip Middle fibers decussate at the angle of the mouth

Action : Compression of the cheeks and lips against the teeth to

prevent food from falling into the vestibule of the mouth Blowing of air

Nerve supply : buccal branch of facial N .

Upperfibers of

buccinator

Lower fibers of buccinator

Parotid duct

Decussatingmiddle fibersof buccinator

Buccinator

Superior constrictorof pharynx

Pterygomandibularraphe

Pterygoid processof sphenoid


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Orbicularis oculiFormed of 3 parts; orbital, palpebral and lacrimal

Orbital portion , Arises from the medial palpebral ligament Forms loops around the ocular orifice

Palpebral portion , Arise from the medial palpebral ligament Restricted to the eyelids

Laterally, the fibers form the lateral palpebral raphe

Lacrimal portion , Fibers which take origin from the posterior lacrimal crest

(behind the lacrimal sac) and from fascia covering lacrimal sac

Action : The palpebral portion closes the eyelids during blinking

The orbital portion is utilized during squeezing of eyelids

The lacrimal portion pulls on the lacrimal fascia to dilate thelacrimal sac, which leads to suction of lacrimal fluid .


Palpebral part of orbicularis oculi

Medial palpebralligament

lateral palpebralraphe

Superior tarsus

inferior tarsus


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Sensory Innervation of the FaceSkin of the face is supplied by branches of the trigeminal nerve (ophthalmic, maxillary and mandibular),EXCEPT the area over the lower half of the ramus of mandible (supplied by great auricular nerve )

Branches from the ophthalmic division of trigeminal Supraorbital n, supplies the forehead Supratrochlear n, supplies the forehead Infratrochlear n (from nasocilary n), supplies medial parts of eyelids and upper part of the nose

Palpebral branches of lacrimal n, supply lateral parts of eyelids External nasal n (from anterior ethmoidal n), supplies lower part of the nose (tip of the nose)

Supratroc hlear

Supraorbital

Palpebral branches

of lacrimal

Infratrochlear

External nasal

Branches fromophthalmic n

Area of the facesupplied by great

auricular n

Area supplied bycervical plexus


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Branches from the maxillary division of trigeminal Zygomatico-facial , supplies skin on the cheek prominence Infraorbital , reaches the face through the infraorbital foramen and divides into:

Palpebral branches to the lower eyelid Nasal branches to the ala of the nose Labial branches to the upper lip

Zygomatico-facial

Infraorbital

Palpebral

Nasal

Labial

Branches of infraorbital n From

maxillary n


auricular n



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Branches from the mandibular division of trigeminal Mental n, reaches the face by passing through the mental foramen, supplies the chin and lower lip Buccal n, supplies skin and mucous membrane of the cheek


auricular n


Buccal n

Mental n

Frommandibular n


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Motor Innervation of the Face

Then it enters the parotid gland , and breaks into its terminal branches which supply muscles of the face 1.Temporal branches2.Zygomatic branches3.Buccal branches4.Marginal mandibular branch5.Cervical branch (supplies the platysma)

Temporal branches

Zygomaticbranches

Marginal

mandibular branch

Buccalbranches

Cervical branch

Posteriorauricular nerve

Main trunkof facial nerve

Nerve to posteriorbelly of digastric and

stylohyoid muscles

Parotid gland

Parotid duct

All muscles of the face, EXCEPT the levator palpebrae superioris , are supplied by the facial nerve The facial nerve leaves the skull by passing through the stylomastoid foramen

Just below the stylomastoid foramen it gives:1.Nerve to the posterior belly of digastric and stylohyoid muscles2.Posterior auricular nerve


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Arterial supply of the faceFacial artery The main source of blood supply to the face It arises from ECA in the neck Reaches the face by piercing the deep fascia at the antero-inferior angle of masseter m.

Runs upward & forward to the angle of mouth Ascends vertically and ends at the medial angle of the eye by anastomosing with the dorsal nasal a.

It gives the following branches in the face:1.Inferior labial a, to the lower lip2.Superior labial a, to the upper lip.3.Lateral nasal a, to the side of the nose

CCA ICA

ECAFacial artery

Inferiorlabial a

Superiorlabial a

Lateralnasal a


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Supartrochlear

Supraorbital

Dorsal nasal

Infraorbital

Transversefacial

Buccal

Facial a

Superficialtemporal a

Other arteries that supply the face Supartrochlear a (from ophthalmic a, ICA ), supplies the forehead Supraorbital a (from ophthalmic a, ICA ), supplies the forehead Dorsal nasal a (from ophthalmic a, ICA ), supplies dorsum of the nose Medial & lateral palpebral a (from ophthalmic a, ICA ), supply the medial & lateral parts of eyelids

Zygomatico-facial a (from lacrimal a, ICA ), comes out of the zygomaticofacial foramen

Buccal a (from maxillary a, ECA ), on the outersurface of buccinator m.

Mental a (from inferior alveolar a, ECA ),comes out of the mental foramen

Infraorbital a (from maxillary a, ECA ), comes out of the infraorbital foramen Transverse facial a (from superficial temporal a, ECA )


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The face receives its arterial supply via branches of the ECA and ICA

Branches from ECA Facial a (from ECA ) Transverse facial a (from superficial temporal, from ECA ) Mental a (from inferior alveolar a, from 1st part of maxillary, from ECA ) Buccal a (from 2nd part of maxillary, from ECA ) Infraorbital a (from 3rd part of maxillary, from ECA )

Branches from ICA Supratrochlear a (from ophthalmic a, from ICA ) Supraorbital a (from ophthalmic a, from ICA ) Dorsal nasal a (from ophthalmic a, from ICA ) Medial palpebral a (from ophthalmic a, from ICA ) Lateral palpebral a (from lacrimal a, from ophthalmic a, from ICA ) Zygomatico-facial a (from lacrimal a, from ophthalmic a, from ICA )

SUMMARY


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Venous Drainage of the Scalp and Face

Retromandibular vein Formed inside the parotid gland by

union of superficial temporal andmaxillary veins It divides into anterior and posterior

divisions which emerge from thelower end of the parotid gland

Supraorbital v

Supratrochlear v

Superficialtemporal v

Ant facial v

Maxillary v

Retromandibular v

Ant branch of retromandibular v

Common facial v

Internal jugular v

Brachiocephalic v

Occipital v

Posterior auricular v

Post branch of retromandibular v

External jugular v

Subclavian v

Communicationwith sup ophthalmic v

Anterior facial vein Formed at the medial angle of the eye by union of supraorbital and supratrochlear veins. It runs behind the facial artery. Crosses the anterior-inferior angle of the masseter and pierces the deep facia to reach the neck It receives tributaries corresponding to branches of the facial artery.


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Supraorbital v

Supratrochlear v

Superficialtemporal v

Ant facial v

Maxillary v

Retromandibular v

Ant branch of retromandibular v

Common facial v

Internal jugular v

Brachiocephalic v

Occipital v

Posterior auricular v

Post branch of retromandibular v

External jugular v

Subclavian v

Communicationwith sup ophthalmic v

External jugular vein Formed by the union of the posterior division of retromandibular vein and the posterior auricular vein It ends in the subclavian vein

Occipital vein Drains into the suboccipital plexus of veins

Common facial vein Formed by the union of the anterior facial vein and the anterior division of retromandibular vein It ends in the internal jugular vein .


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Dangerous area of the face Includes the area of the upper lip and lower nose , extending up to the median region of

forehead and scalp

This region is drained by tributaries of facial vein at its beginning

The facial vein and the supraorbital vein are connected to the superior ophthalmic vein ,which drains into the cavernous sinus

Thus, infection in the dangerous area of the face can be carried to the cavernous sinus

leading to cavernous sinus thrombosis and intracranial infection


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FACE Lateral parts of eyelids drains into preauricular LN

Medial parts of eyelids drain into submandibular

LN The nose, cheek, upper lip and lateral parts of lower lipdrain into the submandibular LN

The central part of lower lip drains into submental LN

Occipital LN

Mastoid LN Submandibular LN Submental LN

Lymphatic drainage of the scalp and faceSCALP The anterior part of the scalp drains into the submandibular LN The temporal region drains into the preauricular LN The posterior part of the scalp drains into the occipital and mastoid LN

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L2 Scalp and Face